#{extends 'main.html' /}
#{set title:'Cadastro de Ficha' /}

<div id="header">
    <div id="logo">
        <div id="logo_text">
            <!-- class="logo_colour", allows you to change the colour of the text -->
            <h1><a href="@{Application.index()}">Si<span class="logo_colour">pro</span></a></h1>
        </div>
    </div>
        
    <div id="Header3"><br/>
        <ul id="menu">
            <!-- put class="selected" in the li tag for the selected page - to highlight which page you're on -->
            <li><a href="@{Application.index()}">Conta</a></li>
            <li class="selected"><a href="@{Application.cadastroFicha()}">Novo Paciente</a></li>
            <li><a href="@{Application.consultarFicha()}">Consultar Ficha</a></li>
            <li><a href="@{Application.gerarRelatorio()}">Relatorios</a></li>
        </ul>
    </div>
</div>

<div id="mainbox"> 

            <br/>
            <div id="Header1">Cadastro de novo paciente</div>
            
            <table width="70%" style="text-align:center;">
                <tr>
                    <td>
                        <br/>
                        <br/>
                        <form action="@{Application.cadastroPaciente()}"  method="GET">
                            <fieldset>
                                <legend>Dados Cadastrais:</legend>
                                <table>
                                    <tr><td style="text-align:right;"><label for="nomepac">Nome: </label></td><td style="text-align:left;"><input type = "text" name="nomepac"></td></tr>
                                    <tr><td style="text-align:right;"><label for="prontpac">Prontuario: </label></td><td style="text-align:left;"><input type = "text" name="prontpac"></td></tr>
                                    <tr><td style="text-align:right;"><label for="diagnostico">Diagnósticos: </label></td><td style="text-align:left;"><textarea rows="10" name="diagnostico" ></textarea></td></tr>
                                    <tr><td style="text-align:right;"><label for="telpac">Telefone: </label></td><td style="text-align:left;"><input type = "text" name="telpac"></td></tr>
                                    <tr><td style="text-align:right;"><label for="sexo">Sexo: </label></td><td style="text-align:left;"><input type="radio" name="sexo" value="m" /> Masculino<input type="radio" name="sexo" value="f" /> Feminino</td></tr>
                                    <tr><td style="text-align:right;"><label for="localpac">Procedência: </label></td><td style="text-align:left;"><input type = "text" name="localpac"></td></tr>
                                    <tr><td style="text-align:right;"><label for="endpac">Endereço: </label></td><td style="text-align:left;"><input type = "text" name="endpac"></td></tr>
                                    <tr><td style="text-align:right;"><label for="historicopac">Histórico Familiar: </label></td><td style="text-align:left;"><input type="radio" name="historicopac" value="true" /> Sim<input type="radio" name="historicopac" value="false" /> Não</td></tr>
                                    <tr><td style="text-align:right;">Nascimento:</td><td width="70%" style="text-align:left;"><input name="dia" type="text" maxlength="2" size="2" ><input name="mes" type="text" maxlength="2" size="2" ><input name="ano" type="text" maxlength="4" size="4" >&nbsp;(dd/mm/aaaa)</td></tr>
                                    <tr><td><br/></td></tr>
                                                        
                                    <tr><td style="text-align:right;" colspan="2">
                                            <table id ="Relatorio">
                                                <tr><th>Histórico de Consultas</th></tr>
                                                <tr><td><br/><br/></td></tr>
                                            </table>
                                    </td></tr>
                                    
                                       <tr><td style="text-align:right;"><input type = "submit" value="Cadastrar" /></td><td style="text-align:left;"><input type = "button" value="Voltar" onclick="goBack()"/></td></tr>
                                </table>
                            </fieldset>
                        </form>	
                    </td>

                </tr>
            </table>

            <br/>
            <br/>
            <br/>
        </div>
            
<div id="rodape">
    <br/>
    <b>DAMGeR</b>
    <br/>
    Sistema de Prontuário
    <br/>
</div>
    